Nurper Denizoğlu, Füsun Taşkın, Gül Esen İçten, Ayşenur Oktay, Özge Aslan, Nermin Tunçbilek, Pınar Balcı, Erkin Arıbal, Levent Çelik, Şebnem Örgüç, Figen Demirkazık, Serap Gültekin, Ayşe Murat Aydın, Emel Durmaz, Sibel Kul, Figen Binokay, Meltem Çetin, Ganime Dilek Emlik, Meltem Gülsün Akpınar, Nuray Voyvoda, Ahmet Veysel Polat, Işıl Başara Akın, Şeyma Yıldız, Necdet Poyraz, Arzu Özsoy, Pelin Öztekin, Eda Elverici, İlkay Koray Bayrak, Türkan İkizceli, Alev Dolu, Funda Dinç, Gülten Sezgin, Gökçe Gülşen, Işıl Tunçbilek, Sabiha Rabia Yalçın, Gül Çolakoğlu, Serpil Ağlamış, Ravza Yılmaz, Günay Rona, Gamze Durhan, Davut Can Güner, Fatma Çelik Yabul, Leman Günbey Karabekmez, Burçin Tutar, Muhammet Göktaş, Onur Buğdaycı, Fatma Tokat, Mustafa Ege Şeker, Cihan Uras
In this retrospective multicenter cohort of surgically excised, biopsy-proven papillary lesions, atypia and several clinical and imaging factors were associated with diagnostic upgrade. These findings may support individualized management decisions in patients with papillary breast lesions.
PURPOSE: This study aimed to determine malignant, high-risk, and overall diagnostic upgrade rates after surgical excision of image-guided biopsy-proven intraductal papillomas and to identify factors associated with overall diagnostic upgrade.
METHODS: In this retrospective multicenter study, 527 surgically excised papillary lesions from 30 centers were evaluated. Malignant upgrade was defined as malignancy at excision after a biopsy diagnosis of papilloma with or without atypia; high-risk upgrade was defined as a high-risk lesion at excision after papilloma without atypia. Overall diagnostic upgrade comprised either outcome. Multivariable logistic regression assessed age, lesion size, risk status, presence of symptoms, and radiologic-pathologic concordance.
RESULTS: Papilloma without atypia accounted for 407 lesions, and papilloma with atypia for 120. The overall malignant upgrade rate was 21.4% (113/527). Among papillomas without atypia, high-risk and malignant upgrade rates were 19.7% (80/407) and 14.2% (58/407), respectively; among papillomas with atypia, malignant upgrade was 45.8% (55/120). Overall diagnostic upgrade occurred in 36.6% (193/527). Multivariable analysis identified older age [odds ratio (OR), 1.03 per year; 95% confidence interval (CI), 1.02-1.05], larger lesion size (OR, 1.02 per mm; 95% CI, 1.00-1.03), presence of symptoms (OR, 1.69; 95% CI, 1.15-2.49), and radiologic-pathologic discordance (concordance OR, 0.54; 95% CI, 0.35-0.84) as independent predictors of upgrade. Microcalcifications (OR, 2.47; 95% CI, 1.27-4.85) and asymmetry (OR, 2.18; 95% CI, 1.12-4.25) on mammography were also significantly associated with upgrade.
CONCLUSION: In this retrospective multicenter cohort of surgically excised, biopsy-proven papillary lesions, atypia and several clinical and imaging factors were associated with diagnostic upgrade. These findings may support individualized management decisions in patients with papillary breast lesions.
CLINICAL SIGNIFICANCE: Identifying clinical and imaging predictors of upgrade may facilitate risk-adapted management of papillary breast lesions and help avoid unnecessary surgical excision in carefully selected patients.